Development of an instrument to assess stress,
depression, and coping among Latino migrant and seasonal
farmworkers.

Abstract:

BACKGROUND: Few assessments of stress and depression have been
developed and validated for use with the Latino migrant and seasonal
farmworker (MSFW) population, and very little research has been
conducted to identify the coping mechanisms used by MSFWs to deal with
these psychological issues. PURPOSE: The purpose was to develop a
culturally sensitive survey instrument to assess stress, depression, and
coping behaviors in Latino MSFWs. DESIGN/ METHODS: Researchers utilized
a comprehensive instrument design framework to develop and pilot test
the instrument. A principal component analysis with direct oblimin
rotation determined item measurement. Alpha reliability coefficients
were calculated for subscales. FINDINGS: Five factors related to stress,
depression, and coping were extracted: Financial, Family Stress;
Physical, Work, Societal Stress; Lack of Documentation and Resources;
Depression; Locus of Control. This resulted in a final 90-item survey
instrument, with seventy-five items measuring stress, depression and
coping, and fifteen demographic questions. CONCLUSIONS: The resulting
instrument contributes to the on-going research in assessment of mental
health in MSFWs.

Currently in the United States (U.S.), Latinos account for
approximately 15% of the population. It is estimated that proportion
will increase to 30% by the year 2050 (US Census Bureau, 2009). In
addition, of the estimated 3-12 million migrant and seasonal farmworkers
(MSFWs) living in the U.S., a majority are Latino (Bureau of Labor
Statistics [BLS], 2008). The federal definition describes MSFWs as
individuals who earn a living in agriculture by migrating, from one
place to another, usually annually, in order to find work (Hovey &
Magana, 2002). In general, these individuals live in the southern
portion of the U.S. for the winter months and will travel north for the
harvest seasons. However, many Latino MSFWs remain in one geographical
area, and will supplement income with non-agricultural jobs in the off
season. The non-migratory nature of this group excludes them from being
classified as "migrants" by the federal definition, and
consequently, they are ineligible for federal benefits, such as migrant
health services (National Center for Farmworker Health [NCFH], N.D.).

According to Barger and Reza, Rothenberg, and Hovey and Magana,
among others, the lifestyle of MSFWs is one of many noted difficulties
(Barger & Reza, 1994; Hovey & Magana, 2002; Rothenberg, 1998).

Approximately 60% of MSFWs live below the poverty line, with many
earning less than $7,500 a year (BLS, 2008). Most are underinsured or
uninsured employees, who provide essential services to the multibillion
dollar agricultural industry in the U.S., in a very dangerous and
hazardous working environment (Hovey & Magana, 2002; NCFH, N.D.).
Farm labor has been documented as having the highest incidence of
workplace fatalities (Hovey & Magana, 2002). Additionally, many
MSFWs live in unsanitary conditions and unsafe environments, physically
isolated from mainstream life (Arcury & Quandt, 2007; Hovey &
Magana, 2002; Wallace, 2002). According to researchers Hovey and Magana
(2002), "small homes that lack water and toilet facilities are
commonplace and drinking water and toilet facilities are not often
readily available in the fields"(p.225). Finally, with limited
access to health and medical care, the health status of MSFWs is among
the worst in the U.S., and the average life expectancy is only 49 years
of age (Hovey & Magana, 2002).

The living and working conditions of MSFWs place these individuals
at increased risk for moderate to high levels of stress and depression
(Hovey & Magana, 2002). Previous research conducted with MSFWs
indicates that one in four has experienced an episode of one or more
psychiatric disorders during their lifetime, nearly twice the prevalence
in the general U.S. adult population (Alderete, Vega, Kolody, &
Aquilar-Gaxiola, 2000). Other studies have revealed that 30-40% of MSFWs
report having clinically significant levels of depressive symptoms in
the past week (Grzywacz et al., 2006; Hiott, Grzywacz, Davis, Quandt,
& Arcury, 2008; Magana & Hovey, 2003). In a study conducted by
Alderete et al. (2000), 21% of the males and 19.7% of the females in the
study reported having depressive symptoms related to language conflict,
lack of social support, discrimination, and legal residence status.
Research conducted by Grzywacz et al. (2008), also indicated that MSFWs
are at increased risk for the development of distress that can lead to
more severe psychiatric disorders, such as depression. Despite the
evidence of the relatively high prevalence of stress and depression in
this population, immigrant Latinos are less likely to seek mental health
services for treatment of mental health conditions (Lawlor & Hopker,
2001; Pomerleau, Zucker, & Stewart, 2003).

Stress has many effects on the lives of individuals themselves,
their relationships with others, and their reactions to situations they
encounter in their environment around them (US Census Bureau, 2009). The
origins of stress, referred to as stressors, are the internal and/or
external demands experienced by an individual that cause distress and
disrupt psychological and physical functional balance or homeostasis.
When faced with this disruption of homeostasis from their stressors,
individuals react through various coping mechanisms (Lazarus &
Cohen, 1977).

Similarly, depression can also have serious negative effects on
emotional, psychological, and physical well-being, and is cited as a
leading cause of disability as well as a major contributor to the global
burden of disease (World Health Organization [WHO], 2009). Negative
health outcomes associated with depression include comorbidity with
chronic diseases such as heart disease, diabetes, arthritis, and asthma
(Moussvi et al., 2007). Depression is a very complex illness, and a
person can experience a variety of symptoms over varying periods of time
in their life. These symptoms include a depressed mood or loss of
interest or pleasure in most activities, accompanied by changes in
appetite or weight, sleep, and psychomotor activity; decrease in energy;
feelings of worthlessness, guilt, or hopelessness; and difficulty in
concentration or decision-making (National Institute of Mental Health
[NIMH], 2006). Generally, the severity of the depression is gauged based
on the frequency and duration of the depressive episode(s). While
persistent or chronic depression usually requires treatment by a health
professional, barriers to such treatment may include lack of access to
health care services, financial constraints, lack of mental health
training among general practitioners, and the stigma associated with
depression (WHO, 2009).

Several studies have reported that, similar to those who suffer
from stress, individuals with depressive symptoms are more likely to
pursue negative behaviors to cope with their depression, such as smoking
and substance use (Daniel et al., 2005; Lawlor & Hopker, 2001;
Pomerleau, Zucker, & Stewart, 2003). They are also more likely to
engage in binge eating and be inactive, which frequently results in
weight gain--a comordity risk factor found to be correlated with
depression (Luppino et al., 2010). Again, as with stress, the pursuit of
positive coping behaviors such as regular exercise, a healthy diet, and
seeking appropriate treatment can help to prevent or mediate depression
(Daniel et al., 2005).

The direct and indirect effects of stress and depression can result
in disruptions of an individual's or group's mental and
physiological well-being, as well as their abilities to perform
responsibilities at work and at home (Shih & Eberhart, 2008).
Positive versus negative mechanisms pursued by individuals to cope with
these conditions can ultimately influence functional status and their
overall health. A solid grasp of the relationship between the occurrence
of stress, depression, and coping behaviors is important in determining
how overall individual and societal health is impacted by these mental
health disorders, and is crucial in providing effective health promotion
and intervention programs to address these debilitating conditions.

Despite the limited number of research studies that have been
conducted, stress and depression among MSFWs are still not well
understood. Few assessments of stress and depression have been developed
and validated for use with this population, and very little research has
been conducted to identify the coping mechanisms used by MSFWs to deal
with these psychological issues (Grzywacz et al., 2008). Grzywacz and
colleagues warn researchers to be cautious when selecting instruments to
assess MSFW mental health, as working with this population to document
mental health issues can present several challenges related to
measurement and data collection, including: 1) cross-cultural
equivalence of items used for surveillance research, 2) variations in
Spanish terms used and spoken by workers from different regions of
Mexico or other countries, and 3) low education levels (Grzywacz et al.,
2008). In addition, these researchers point to the lack of studies that
examine the efficacy of using survey-based research to collect data in
this population.

To help address these research issues, Grzywacz and colleagues
provide suggestions regarding the methodology that researchers should
use in selecting instruments when working with MSFWs and mental health
(Grzywacz et al., 2008). These suggestions, coupled with the fact that
minimal research has been conducted to examine coping behaviors in this
unique population, elevate the need for additional research on
instrument development and data collection to assess mental health in
MSFWs. To this end, the purpose of this study was to develop a
culturally sensitive survey instrument to assess stress, depression, and
coping behaviors in Latino MSFWs. The instrument was developed, pilot
tested, and used to gather pilot data on stress, depression, and coping
behaviors among MSFWs within three agricultural counties in eastern
North Carolina.

INSTRUMENT DESIGN FRAMEWORK

The process of test development outlined in the Standards for
Educational and Psychological Testing, along with Dillman's four
stages of pretesting, were used to construct the instrument (Dillman,
2000; Standards, 1999).

STEP 1--PURPOSE OF INSTRUMENT

To begin instrument construction, the Standards suggest identifying
the constructs to be measured by the items of the instrument (Standards,
1999). For this instrument, the constructs to be measured are stress,
depression, and coping behaviors, along with measures of locus of
control. Locus of control explains an individual's perceptions of
where control over their life events resides (Rotter, 1966). In this
case, the instrument items measure locus of control in terms of control
over stressors, factors contributing to depression, overall health, and
coping behaviors. The scope of the measured constructs is based on the
work of many researchers, who have measured mental health in Latino
MSFWs and/or coping behaviors, particularly, Grzywacz and colleagues,
Folkman, Lazarus, Gruen, and DeLongis, Hovey and Magana, and Cervantes,
Padilla, De Snyder, as well as Kung, Castaneda, and Lee, and Moos
(Cervantes, Padilla, & De Snyder, 1990; Folkman, Lazarus, Gruen,
& DeLongis, 1986; Grzywacz, 2008; Hovey & Magana, 2002; Kung,
Castaneda, & Lee, 2003; Moos, 1993).

STEP 2--TEST SPECIFICATIONS

The second step in instrument design is to identify the test
specifications. According to the Standards (1999), "the test
specifications delineate the format of items, tasks, or questions; the
response format or conditions for responding; and the type of scoring
procedures" (p.38). The items for this instrument are a combination
of Likert scale questions, open-ended questions, and
check-all-that-apply questions.

The instrument items were formatted and developed with issues of
fairness in mind. Issues of fairness refer to the idea "that
examinees of equal standing with respect to the construct the test is
intended to measure should on average earn the same test score,
irrespective of group membership" (Standards, 1999, p.74).
Therefore, the instrument was constructed to establish equality of
measures and outcomes for respondents, regardless of gender, race,
ethnicity, or any other characteristic (Standards, 1999). The population
of interest is Latino MSFWs, and therefore, the items were developed
with this group, in particular, in mind.

Additionally, issues of bias refer to "construct-irrelevant
components that result in systematically lower or higher scores for
identifiable groups of examinees" (Standards, 1999, p.76).
Content-related bias results when test content is inappropriate for the
population of interest; however, test developers can assemble a panel of
diverse experts to review the instrument for content, language, and
questions that might be offensive or disturbing to groups of test
takers. A panel was assembled for this instrument development process,
and will be explained in the following steps of pretesting.

STEP 3--DEVELOPMENT OF A POOL OF ITEMS

Three focus groups were conducted with a total of 29 MSFWs in
eastern North Carolina at community sites. One focus group was conducted
on a tobacco farm following the worker's shift (N = 10), the second
was conducted in a Latino community clinic waiting room after hours (N =
12), and the third was conducted in a closed mercado (market) (N = 7). A
trusted community gatekeeper conducted the focus groups in Spanish.

Participants were greeted and welcomed by the research team. All
participants provided verbal informed consent. Verbal consent was used
per the University's Institutional Review Board to ensure the
confidentiality and anonymity of undocumented residents. All
participants agreed to allow the focus groups to be audiotaped with a
digital audio player. The researcher then labeled the transcribed
interview data in NVivo QSR with codes based on thematic representation
of participant's meaning.

The final sample included 29 participants. Twenty-six participants
were Mexican immigrants, and 3 were from Guatemala. Twenty-three of the
participants worked in agricultural farms, 3 were welders, 3 were
retired farmworkers, 1 was an outreach worker, and 1 an office worker
for a community clinic. The average age of participants was 35 with the
range being 18-83. There were 15 females and 14 males.

The results of this qualitative data collection will not be
discussed in detail here, but four important themes emerged from this
data collection that helped in the creation of the instrument items: 1)
physical stress related to working conditions; 2) mental stress related
to family situations, work environment, documentation status, and the
lack of resources; 3) depression related to separation from family and
the lack of resources; and 4) use of positive and negative mechanisms
for coping with stress and depression. Based on these qualitative
findings, along with the work of Grzywacz and colleagues, Folkman,
Lazarus, Gruen, and DeLongis, Hovey and Magana, and Cervantes, Padilla,
Snyder, as well as Kung, Castaneda, and Lee, Moos, and Doyle, Rager,
Bates, and Cooper, items were developed or chosen based on the
constructs to be measured (stress, depression, coping, and locus of
control) (Cervantes, Padilla, & De Snyder, 1990; Folkman, Lazarus,
Gruen, & DeLongis, 1986; Grzywacz, 2008; Hovey & Magana, 2002;
Kung, Castaneda, & Lee, 2003; Moos, 1993; Doyle, Rager, Bates, &
Cooper, 2006). An initial pool of items was drawn from these sources; in
addition, Dillman's Tailored Design Method was used to construct
new items (Dillman, 2000). The initial pool consisted of 93 items.

STEP 4--DILLMAN'S FOUR STAGES OF PRETESTING

Once Institutional Review Board approval was obtained, the pool of
items was subjected to Dillman's four stages of pretesting
(Dillman, 2000). Methods and results of this four-stage process are
outlined below in sequential order.

Stage 1--Review by knowledgeable colleagues and analysts

Methods

The initial pool of items was sent to a panel of five national
experts to review. Expertise areas included: MSFW mental health,
cultural and linguistic challenges in working with MSFWs, survey
development, and general mental health issues. The main goal of this
stage was "to finalize the substantive content of the questionnaire
so the construction process can be undertaken" (Dillman, 2000,
p.141). The panel was also responsible for evaluating evidence of
content-related bias and cultural sensitivity issues in the instrument.
For example, the panel was asked to identify areas where test content
appeared inappropriate for the MSFW population.

The panel was asked to review and rank each item on a scale from 1
to 4, with 1 = not important to include in survey, 2 = somewhat
important to include in survey, 3 = important to include in survey, and
4 = extremely important to include in survey. Also, to minimize the
number of similar items that measured the same construct, panel members
were asked to label items as either "keep" or
"omit". As a final task in Stage 1, panel members evaluated
the instrument for face validity (i.e. the items appear to be relevant
to the constructs being investigated) and content validity (Gomm,
Needham, & Bullman, 2000).

Statistical Analysis/Results

The results of the panel review for face and content validity
indicated that 17 items needed slight wording modifications. An
additional 7 items were identified as being either redundant or not
adequately measuring the intended construct; therefore, these items were
completely deleted. The criteria for deleting other items involved the
rankings of panel members. The rankings of each item from panel
reviewers were assessed, and if a majority (3 or more reviewers)
indicated the item was either important or extremely important to
include in the survey and suggested to keep the item, then it was kept
and included in the pilot study instrument. In addition, based on
recommendations of panel members, 9 new items were added to the
instrument. Three of these were demographic questions, four dealt with
types of stressors, and the remaining two were items measuring coping
behaviors.

Modifications recommended by the panel of experts resulted in a
95-item instrument to be tested in the pilot study, with six subscales
and a demographics section. The items were grouped into subscales, based
on the authors' determination of what constructs the items
measured. Subscale I (10 items) measured MSFW physical stress levels, by
asking farmworkers to think about feelings of stress within the past 6
months, in relationship to the content in each item (Likert scale items
ranging from 1 = not at all to 5 = yes, most of the time). An example of
these items is, "In the past six months, have you felt stressed
because of painful injuries you suffered at work?" Subscale II (46
items) consisted of mental stress items, which is a rather complex
construct to measure; hence, the higher number of items utilized. The
first 45 items in Subscale II were Likert-type scale items that inquired
about frequency of stress and types of stressors, ranging from 1 = not
at all to 5 = yes, most of the time. For example, the respondent was
asked, "In the past six months, have you felt stressed because of
not having enough work?" The last item in the mental stress scale
was an open-ended item that asked respondents to list "other things
that caused [farmworkers] to have feelings of stress at work or in
[their] personal life." Items in Subscale III (11 items) were
questions designed to assess depression levels in MSFWs. Again,
Likert-scale formatting was used in this subscale to assess frequency of
depressive symptoms, and the responses ranged from 1 = none of the time
to 5 = all of the time. Subscale IV (5 items) was composed of questions
on coping behaviors. Four of the five questions were Likert-scale items,
measuring general stress levels and perceptions of how well MSFWs cope
with stress, and the last item was a "check all that apply"
item that listed 34 coping behaviors, cited in the literature as
behaviors of MSFWs, and one open-ended item for "other
behaviors" to be listed. Respondents were asked to place a check by
the behaviors in which they engage to cope with stressors. Subscale V (2
items) measured coping behaviors with depression by asking one general
question regarding self-perception of depressive symptoms, and a
"check all that apply" question with 33 coping behaviors
listed. Respondents were asked to check all behaviors that apply to
their situation, and were given the opportunity to list additional
behaviors not included in the list. Subscale VI (6 items) consisted of
locus of control items that measured MSFWs' beliefs regarding
what/who controls happenings in their life. Six Likert-scale items,
ranging from 1=strongly disagree to 5 = strongly agree, were used. An
example item follows, "My life is mostly controlled by accidental
happenings." Lastly, a Demographics section (15 items) composed of
demographic questions was included at the end of the survey. The
instrument was translated into Spanish and back to English by
professional translators proficient in both migrant and health-based
language translation, and was reviewed by three community gatekeepers
for correct dialect and terminology usage.

Stage 2--Interviews to evaluate cognitive and motivational
qualities

Methods

In this stage, using the 95-item survey, 10 MSFWs, from one eastern
North Carolina county were interviewed individually by a bilingual
interviewer. The interviewer was considered the gatekeeper of the MSFW
population, and was trained on how to conduct the interviews with
participants. Respondents were asked to think out loud when answering
questions. According to Dillman (2000), the interviewer should probe the
respondents "to get an understanding of how each question is being
interpreted and whether the intent of each question is being
realized" (p.142). Cognitive interviewing, such as this "is
designed to produce information when the respondent is confused or
cannot answer a question" (Dillman, 2000, p. 142).

Results

The cognitive interviews resulted in minor modifications to wording
on 7 items. As an example, one physical stress item asked "In the
past six months, have you felt stressed because of pain resulting from
laborious work?" It was changed to read, "In the past six
months, have you felt stressed because of pain from having to work too
hard?" Additionally, minor grammatical edits were made. No item was
deleted as a result of the cognitive interview process. The consensus of
the 10 MSFW participants was that the instrument was appropriate and
items were easily understood. Therefore, the 95-item instrument was
administered to a sample population for the pilot test.

Stage 3--A pilot test

Methods

The pilot study methodology was devised to emulate methods and
procedures to be used in follow-up studies. A small convenience sample
of MSFWs (n = 60) was recruited from an eastern North Carolina migrant
farmworker camp to participate in the study. Each participant was given
a $10 gift card as incentive for participating. Three bilingual,
community gatekeepers administered the instrument to the participants.
The gatekeepers were trusted individuals in this population, and were
trained in survey administration. An informed consent statement was read
in Spanish to the pilot study group, prior to administration of the
instrument, and all of them agreed to the statement and participated.
Responses were kept confidential, and participants were asked not to put
any identifiable information on the surveys.

Statistical Analysis

Due to the vast number of items pooled and developed for the
instrument, an investigation into desired variable measurement of a
single or multiple underlying construct(s) was warranted. A principal
component analysis (PCA) was utilized to identify factors, using Version
17.0 of the SPSS for Windows, with a direct oblimin rotation (to account
for factor correlations) (SPSS, 2007). Additionally, the scree test and
Kaiser's criterion of retaining all factors with eigenvalues
greater than 1 was used to determine the number of factors to retain
(Cattell,, 1966; Kaiser, 1960). The purpose of the PCA in the pilot
study was only to make reliable generalizations of the measured
variables to the sample, not to make inferences to an entire population
(beyond the sample). Follow-up studies will be conducted for hypothesis
testing and making population-based inferences. Additionally, the
oblique rotation technique was chosen to account for correlation between
factors. Alpha reliability coefficients were also calculated for the
extracted factors (Cronbach, 1951).

Results

Sample Characteristics

An analysis of the pilot group demographics indicated that a
majority of the sample was male (91.2%) (Table 1). Age of the
participants ranged from 20 to 75 years old, with a majority between
ages 24-42. Approximately 67% of participants were married, and over
96.3% were identified as Hispanic/ Latino. Approximately 90% of the
MSFWs claimed Mexico as their birthplace; Honduras accounted for
approximately 8% of responses. Seventy-five percent of participants
indicated they did not reside alone. Of that 75%, a majority (58.3%)
reported living with at least 5 other individuals. Approximately 46% of
the participants indicated having at least some high school education,
with over 19% having post high school training. When asked how much work
they conducted throughout the past year, a majority of respondents
replied they worked either "most of the year" (32.7%) or
"half of the year" (47.3%), with 75.4% citing work weeks of 40
or more hours. About two-thirds of the respondents had average monthly
salaries of $1,000 or less, with 15.5% earning less than $500, 53.4%
earning $501-$1000, and 31% earning over $1000. Approximately 49% of the
sample had lived in the United States for less than two years, and over
80% indicated Spanish as their primary language.

PCA Results

Bartlett's test of sphericity was conducted to examine the
correlation of variables. The result was statistically significant
(pReliability Measures

Cronbach's alpha was assessed for the five extracted factors
(Cronbach, 1951). Reliability measures were above the acceptable 0.70
alpha coefficient for Factors 1-4; however, Factor 5, the locus of
control subscale, resulted in poor reliability measures ([alpha] =
0.589) (see Table 3) (Gable & Wolf, 1993). Therefore, these items
were deleted from the final instrument. Cronbach's alpha was also
assessed for each scale by eliminating one item at a time to see if
reliability improved by deleting items; however, no deletion improved
the alpha coefficient significantly (improvement fell between 0.0010 and
0.0162). Therefore, no additional items were deleted from the
reliability analysis.

Stage 4--A final check.

Methods

Finally, test developers should consult with a few people, who have
had no part in instrument development, to check for any problems
(Dillman, 2000). In the current study, two additional experts were asked
to review the survey for problems with wording or content.

Results

The final check resulted in no additional changes or modifications
to the instrument. Therefore, the instrument design framework and the
statistical analyses yielded a 90-item instrument, as a result of the
deletion of the locus of control items. The 11 items that yielded high
percentages of missing data were kept in the final form, in order to
retest these items in a larger sample. The final instrument measures
general stress, depression and coping behaviors, the five extracted
factors, and demographic information for MSFWs in eastern North
Carolina. Future studies are warranted to subject the final form of the
instrument to additional model testing, with a larger, more
representative sample of MSFWs.

DISCUSSION

The purpose of the study was to develop a culturally sensitive
instrument to assess stress, depression and coping behaviors among
MSFWs. To that end, the aforementioned instrument design framework was
utilized to develop items to be pilot-tested with 60 MSFWs in eastern
North Carolina. Factors associated with work-related, family-related,
financial-related and societal-related stress and depression were
identified, and mechanisms of coping with stress and depression were
assessed. Collectively, the results provide researchers with an
instrument that produced valid and reliable scores to items measuring
the five extracted factors in the study sample; however, further testing
of the model needs to be conducted, with a larger sample of MSFWs, to
validate the subscales designed in this study. With that being said, the
results of this study provide substantial background research for future
studies in assessment of the underlying factors associated with these
mental health issues in the MSFW population.

The study methodology highlighted and discovered the challenges
that Grzywacz and colleagues identified in selecting instruments to
collect data on the mental health of farmworkers, as 11 items in the
original instrument, mostly measuring negative health behaviors as forms
of stressors (alcohol use, gambling, violence, etc), resulted in high
percentages of missing data (Grzywacz et al., 2008). Therefore, using
such items to collect data on these behaviors, for this sample, may not
prove to be the best data collection method with this group. In
addition, selection bias due to the small sample size is a limitation to
this pilot study. As mentioned previously, the results of this study
should be tested with a larger, more representative sample. Lastly,
response bias, particularly social desirability of MSFWs in the sample
to answer the way in which they perceive appropriate, may play a role in
the results. The desirability of this group to avoid reporting actual
work-related stressors (as it relates to work conditions, treatment from
boss, etc.) may have biased data, as MSFWs do not want to jeopardize
their opportunity to continue working (Grzywacz et al., 2008). These
realities warrant the question of which data collection method is most
appropriate when working with MSFWs. The results of this study support
the research findings of Grzywacz and colleagues that when assessing
mental health issues in MSFW populations, researchers must be cautious
in how data are collected and with what types of data collection tools
(Grzywacs et al., 2008). Additional survey research is needed to examine
item development and mental health construct measurement.

Notwithstanding the noted limitations of the current study, the
resulting instrument contributes to the on-going research in assessment
of mental health in MSFWs. In addition, the instrument incorporates the
scale for coping behavior assessment, which begins to fill a void in the
literature on coping mechanisms used by MSFWs. A key element of the
instrument is that development was based on qualitative research, along
with a comprehensive instrument design framework, in order to ensure the
instrument was culturally appropriate. The researchers collaborated with
additional experts, who work with the MSFW population on a regular
basis, to ensure the survey was more than a stress or depression
inventory instrument that was created for Caucasians and translated to
Spanish; it was developed specifically for the MSFW population. With
evidence indicating an elevated prevalence of mental health problems and
psychiatric disorders in this population, more research needs to be
conducted to identify and assess factors associated mental health, in
order to provide needed resources to a population that is often
forgotten by mainstream society.

ACKNOWLEDGEMENTS

Funding for this research study was provided by an internal
Research and Development Grant awarded by East Carolina University
(ECU). The authors would like to acknowledge Dr. Jason Brinkley,
Assistant Professor in the Department of Biostatistics at ECU, for his
suggestions on the chosen data analyses. In addition, the authors wish
to thank the gatekeepers and the many Migrant Farmworkers in rural
eastern North Carolina that have made this research and manuscript
possible.

Standards for Educational and Psychological Testing. (1999).
Washington, DC: American Educational Research Association, American
Psychological Association, and National Council on Measurement in
Education.

U.S. Census Bureau. (2008). Percent of the Projected Population by
Race and Hispanic Origin for the United States, 2008 to 2050. Retrieved
from http://www.census.gov/population/www/projections/
tablesandcharts/table_4.xls.

Table 1. Demographic Characteristics of Sample
Gender N Valid Years Living in the United States
Percent
Male 52 91.2% Less than 1 year 24 42.1%
Female 5 8.8% 1-2 years 4 7%
Age 3-5 years 7 12.3%
20-30 16 31.5% 6-10 years 8 14%
31-40 14 27.0% More than 10 years 14 24.6%
41-50 15 29.6% Work in the N Valid
Past Year Percent
51-60 3 5.9% All year 6 10.9%
61-70 2 4.0% Most of the year 18 32.7%
Over 71 1 2.0% Half of the year 26 47.3%
Years in School Less than half 5 9.1%
of the year
0 to 4 years 7 13.5% Daily Work Hours
5 to 8 years 16 30.8% 3-5 hours 2 3.5%
Some high 7 13.5% 6-8 hours 12 21.1%
school
Completed 12 23.1% 8-10 hours 24 42.1%
high school
Post high 9 19.1% More than 10 hours 19 33.3%
school
Race/Ethnicity N Valid Salary
Percent
Hispanic/Latino 52 96.3% Less than $500 9 15.5%
per month
Other 1 3.7% $501 to $1000 31 53.4%
per month
Birthplace $1001 to $2000 18 31%
Honduras 5 8.2% per month
Mexico 54 90.1%
El Salvador 1 1.7%
Table 2. Results of a Principal Component Analysis with
Oblimin Rotation and Kaiser Normalization
Survey Item F1 F2 F3 F4 F5
In the past six months, 0.56
have you felt stressed because
of painful injuries you
suffered at work?
In the past six months, have 0.45
you felt stressed because
of pain caused by
your work?
In the past six months, have 0.69
you felt stressed because
your work is too hard
(i.e. physically demanding)?
In the past six months, have 0.37 0.47
you felt stressed because
of how fast you had to work?
In the past six months, have 0.65
you felt stressed because
you had to work
long hours?
In the past six months, have 0.45
you felt stressed because
of the temperature
in which you had to work
(too hot or too cold)?
In the past six months, have 0.70
you felt stressed because
of how tired you
feel during work?
In the past six months, have 0.62
you felt stressed because
your work requires
you to stand all day?
In the past six months, have 0.62
you felt stressed because
of pain caused by
household duties and/or
activities?
In the past six months, have 0.56
you felt stressed because
of how tired you
feel while at home?
In the past six months, have 0.55
you felt stressed because
of not having enough work?
In the past six months, have 0.51
you felt stressed because
of unfair treatment at work?
In the past six months, have
you felt stressed because
of pressure from your boss?
In the past six months, have 0.59
you felt stressed because
of lack of money?
In the past six months, have 0.61
you felt stressed because
of the current economic
problems in this country?
In the past six months, have 0.40
you felt stressed because
of medical bills?
In the past six months, have 0.41
you felt stressed that
you won't get the medical
help you need?
In the past six months, have
you felt stressed because
of sickness in your
family?
In the past six months, have
you felt stressed because
members of your
family have issues that you
cannot solve?
In the past six months, have 0.57 0.43
you felt stressed because
of family responsibilities?
In the past six months, have 0.62
you felt stressed about
not being able to send money
back to your family in your
home country?
In the past six months, have 0.74
you felt stressed because
of house work after
work?
In the past six months, have 0.61
you felt stressed because
of childcare duties?
In the past six months, have
you felt stressed because
of problems with your
children?
In the past six months, have 0.51
you felt stressed because
of problems with your
spouse?
In the past six months, have 0.46 0.45
you felt stressed because
of lack of help with
household chores?
In the past six months, have 0.65
you been stressed about
where to leave your
children while working?
In the past six months, have 0.72
you felt stressed because
your family lives far
away or in another country?
In the past six months, have 0.73
you felt stressed because you
are unable to see your
family while working in
this country?
In the past six months, have 0.41 0.36
you felt stressed because there
is a lack of communication
in your household?
In the past six months, have 0.88
you felt stressed because
of a lack of legal
documentation to work in
this country?
In the past six months, have 0.88
you felt stressed because
you do not have a
driver's license?
In the past six months, have 0.62
you felt stressed because
you do not have your
own transportation?
In the past six months, have 0.50
you felt stressed because
of the time spent
going to and from work?
In the past six months, 0.48
have you felt stressed
because someone in your
household has a
drinking problem?
In the past six months, 0.42
have you felt stressed
because someone in your
household has a drug problem?
In the past six months, have
you felt stressed
because someone in your
household has a
gambling problem?
In the past six months, have
you felt stressed because
you think you drink
too much alcohol?
In the past six months, have
you felt stressed because
you think you use too
many illegal drugs?
In the past six months, have
you felt stressed because
you think you gamble
too much?
In the past six months, have
you felt stressed because
of violence in your
household?
In the past six months, have 0.456
you felt stressed because
of unfair treatment
in your community?
In the past six months, have 0.41
you felt stressed because
of unfair treatment
in this country?
In the past six months, have 0.44
you felt stressed because
of crime in your
community?
In the past six months, have 0.56 -0.43
you felt stressed because
you have problems
speaking English?
In the past six months, have 0.55
you felt stressed that
your job causes you
health problems?
In the past six months, have 0.58 0.49
you felt stressed because
you do not enjoy your
job?
In the past six months, have 0.82
you felt stressed about
not being able to make enough
money for your family who
lives with you?
In the past six months, have 0.90
you felt stressed that
you may be deported?
In the past six months, have 0.74
you felt stressed that
your family may forget
the values of your culture?
In the past six months, have 0.78
you felt stressed that
your children may not
have a chance for a
better life?
In the past six months, have 0.43
you felt stressed because
your life at home is
not getting better?
In the past six months, have 0.47
you felt stressed because
your life at work is
not getting better?
In the past six months, have 0.51 -0.54
you felt stressed about
getting sick and not
being able to work?
In the past six months, have 0.62
you felt stressed that
you are unable to get
the education that you need?
Over the past six months, how 0.79
would you describe
your level of stress in
your personal life?
Over the past six months, how 0.42
often have you had
trouble coping with
stress in your personal life?
Over the past six months, how 0.59
would you describe
your level of stress
in your work life?
Over the past six months, how 0.46
often have you had
trouble coping with
stress in your work life?
My life is mostly controlled 0.55
by accidental happenings.
What happens in my life 0.52
is mostly determined
by other people.
God controls most of what 0.62
happens in my life.
Evil spirits or curses can -0.63
affect what happens in my life.
My own actions determine
my life.
What happens in my life 0.46
is mostly controlled
by other people.
What happens in my life is a -0.60
matter of fate or destiny.
During the past six months, how 0.50
often have you felt sad,
depressed, or
hopeless for 2 or more
weeks at a time?
How often in the past six 0.41
months have you felts sad,
depressed, or hopeless
due to health problems?
How often in the past six 0.41
months have you felts
sad, depressed, or hopeless
because of living conditions?
How often during the past six 0.42
months, have you felt
sad, depressed, or
hopeless?
How often in the past six 0.40 0.58
months have you felts
sad, depressed, or hopeless
because of family problems?
How often in the past six 0.40
months have you felts sad,
depressed, or hopeless
because of work problems?
How often in the past six
months have you felts
sad, depressed, or hopeless
because of working conditions?
How often, during the past six 0.64
months, have you had difficulty
carrying out normal activities
at home?
How often during the past six 0.60
months, have you felt nothing
can cheer you up?
How often during the past six 0.43
months, have you lost
sleep because of
feelings of sadness,
depression, or hopelessness?
How often, during the past six 0.42
months, have you had
difficulty carrying out
normal activities at work?
F1 = Financial, Family Stress
(20 items), F2 = Physical,
Work , Societal
Stress (22 items),
F3 = Lack of Documentation and
Resources (8 items),
F4=Depression (12 items),
F5 = Locus of Control
(5 items)
Table 3. Reliability Measures
for Subscales
Scale Cronbach's
alpha
Financial and 0.915
Family Stress
Physical, Work 0.912
and Societal Stress
Stress due to Lack 0.877
of Documentation
and Resources
Depression 0.904
Locus of Control 0.589
Note: Locus of Control subscale was deleted from the final
instrument, as the reliability measures were poor.